On-line apnea-bradycardia detection using hidden semi-Markov models.

International audienceIn this work, we propose a detection method that exploits not only the instantaneous values, but also the intrinsic dynamics of the RR series, for the detection of apnea-bradycardia episodes in preterm infants. A hidden semi-Markov model is proposed to represent and characterize the temporal evolution of observed RR series and different pre-processing methods of these series are investigated. This approach is quantitatively evaluated through synthetic and real signals, the latter being acquired in neonatal intensive care units (NICU). Compared to two conventional detectors used in NICU our best detector shows an improvement of around 13% in sensitivity and 7% in specificity. Furthermore, a reduced detection delay of approximately 3 seconds is obtained with respect to conventional detectors

The Digi-NewB project for preterm infant sepsis risk and maturity analysis

It is known from the literature that the careful analysis of the heart rate variability of a preterm infant can be used as a predictor of sepsis. The Digi-NewB project aims at collecting a database of at least 750 preterm infants including physiological signals, video and clinical observations. These data are used to design a decision support system for the early detection of sepsis and for the evaluation of the infant maturity. The preparation of the data for the exploratory analysis has turned out to be time-consuming. 190 infants have been recorded by March 2018 and of these, the R-R interval analysis of the ECG signals has been completed of 136 infants. The results of the project are still preliminary but seven heart rate variability parameters have been found to be different in preterm and full-term infants with a P value less than 0.01. The video analysis algorithm detecting the presence of personnel or relatives reached 96.8% of sensitivity and 95.1% of specificity.It is known from the literature that the careful analysis of the heart rate variability of a preterm infant can be used as a predictor of sepsis. The Digi-NewB project aims at collecting a database of at least 750 preterm infants including physiological signals, video and clinical observations. These data are used to design a decision support system for the early detection of sepsis and for the evaluation of the infant maturity. The preparation of the data for the exploratory analysis has turned out to be time-consuming. 190 infants have been recorded by March 2018 and of these, the R-R interval analysis of the ECG signals has been completed of 136 infants. The results of the project are still preliminary but seven heart rate variability parameters have been found to be different in preterm and full-term infants with a P value less than 0.01. The video analysis algorithm detecting the presence of personnel or relatives reached 96.8% of sensitivity and 95.1% of specificity

Time-frequency relationships between heart rate and respiration: A diagnosis tool for late onset sepsis in sick premature infants

International audienceThe diagnosis of late onset sepsis in premature infants remains difficult because clinical signs are subtle and non-specific and none of the laboratory tests, including CRP and blood culture, have high predictive accuracy. Heart rate variability (HRV) analysis emerges as a promising diagnostic tool. Entropy and long-range fractal correlation are decreased in premature infants with proven sepsis. Besides this, respiration and its relations to HRV appear to be less. The objective of this study was to determine if analysis of time-frequency correlations between the heart rate and respiration amplitude may help for the diagnosis of infection in premature infants. An estimator of the linear relationship between nonstationary signals, recently introduced, is explored. The tests were performed on a cohort study of 60 premature infants. The results show that the correlation in the low frequency band tended to be higher in the sepsis group

A model-based approach for the evaluation of vagal and sympathetic activities in a newborn lamb.

International audienceThis paper proposes a baroreflex model and a recursive identification method to estimate the time-varying vagal and sympathetic contributions to heart rate variability during autonomic maneuvers. The baroreflex model includes baroreceptors, cardiovascular control center, parasympathetic and sympathetic pathways. The gains of the global afferent sympathetic and vagal pathways are identified recursively. The method has been validated on data from newborn lambs, which have been acquired during the application of an autonomic maneuver, without medication and under beta-blockers. Results show a close match between experimental and simulated signals under both conditions. The vagal and sympathetic contributions have been simulated and, as expected, it is possible to observe different baroreflex responses under beta-blockers compared to baseline conditions

Caesarean section at term: the relationship between neonatal respiratory morbidity and microviscosity in amniotic fluid.

None of the authors report any conflicts of interest.International audienceOBJECTIVES: The incidence of neonatal respiratory morbidity following an elective caesarean section is 2-3 times higher than after a vaginal delivery. The microviscosity of surfactant phospholipids, as measured with fluorescence polarisation, is linked with the functional characteristics of fetal surfactant and thus fetal lung maturity, but so far this point has received little attention in new-borns at term. The aim of the study is to evaluate the correlation between neonatal respiratory morbidity and amniotic microviscosity (Fluorescence Polarisation Index) in women undergoing caesarean section after 37 weeks' gestation. STUDY DESIGN: The files of 136 women who had undergone amniotic microviscosity studies during elective caesarean deliveries at term were anonymised. Amniotic fluid immaturity (AFI) was defined as a Fluorescence Polarisation Index higher than 0.335. RESULTS: Respiratory morbidity was observed in 10 babies (7.3%) and was independently associated with AFI (OR: 6.11 [95% CI, 1.20-31.1] with p=0.029) and maternal body mass index (OR: 1.12 [95% CI, 1.02-1.22] with p=0.019). Gestational age at the time of caesarean delivery was inversely associated with AFI (odds ratio, 0.46 [95% confidence interval, 0.29-0.71], p<0.001), especially before 39 weeks, and female gender was associated with an increased risk (odds ratio, 3.29 [95% confidence interval, 1.48-7.31], p=0.004). CONCLUSIONS: AFI assessed by amniotic microviscosity was significantly associated with respiratory morbidity and independently correlated with shorter gestational age especially before 39 weeks. This finding provides a physiological rationale for recommending delaying elective caesarean section delivery until 39 weeks of gestation to decrease the risk for respiratory morbidity

INTERET ET LIMITES DE L'ETUDE DE LA VARIABILITE PHYSIOLOGIQUE DES PARAMETRES CARDIOVASCULAIRES (APPLICATIONS A L'ETUDE DU RYTHME CARDIAQUE, DE LA REPOLARISATION VENTRICULAIRE ET DE LA PRESSION ARTERIELLE (DOCTORAT : BIOLOGIE ET SCIENCES DE LA SANTE))

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Intérêt du propranolol dans le traitement des chorioangiomes géants évolutifs

Introduction: Le chorioangiome est une tumeur bénigne retrouvée dans environ 1% des examens placentaires. Cette malformation vasculaire dont l'histologie se rapproche de celle des hémangiomes infantiles (HI) peut être à l'origine de complications foeto-maternelles. Hypothèse: Le propranolol qui est efficace pour le traitement des HI pourrait avoir un effet favorable sur les chorioangiomes géants (>4cm). Objectif: Etudier à propos d'un cas clinique, la pertinence de proposer le propranolol dont l'utilisation est connue en obstétrique, comme une alternative dans le traitement des chorioangiomes géants évolutifs. Cas clinique: Un traitement par propranolol a été proposé à une femme de 29 ans présentant un diagnostic de chorioangiome géant évolutif à 19 SA. Le traitement a été débuté à 32 SA à la posologie de 40mg/8h. L'évolution a été favorable et la grossesse à pu être menée à terme sans complication. Conclusion: A l'issue de l'analyse de ce cas les auteurs proposent de tester cette molécule dans cette indication. Pour se faire ils réalisent une revue de la littérature sur l'histoire naturelle des choriangiomes ainsi que sur l'emploi du propranolol à la fois au cours de la grossesse et pour traiter les HI.Introduction: A chorioangioma is a benign tumor found in about 1% of placental examinations. This is a vascular malformation which histology is similar to that of infantile hemangiomas (IH) and it may cause fetomaternal complications. Hypothesis: Propranolol is effective for the treatment of IH and could have a favorable effect on giant chorioangiomas (>4cm). Target: Study with a clinical case, the relevance of the use of propranolol which is known in obstetrics as an alternative in the treatment of giant scalable chorioangiomas. Clinical case: A treatment with propranolol was offered to a 29 year old woman with a diagnosis of giant evolutionary chorioangioma at 19th weeks of amenorrhea (WA). Treatment begun at 32 weeks at a dose of 40mg/8h. The evolution was favorable and pregnancy could be completed without complications. Conclusion: Following the analysis of this case, the authors propose to test this molecule in this indication. To do they make a review of the literature about the natural history of chorioangiomas and about the use of propranolol during pregnancy and outside to treat IH.RENNES1-BU Santé (352382103) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Leucomalacie péri-ventriculaire kystique et corticothérapie post-natale précoce (situation de raréfaction vasculaire ?)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

ANALYSE DES MOTIVATIONS DU RECOURS DIRECT AUX URGENCES MEDICALES PEDIATRIQUES HOSPITALIERES

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Caffeine for apnea in bronchiolitis

International audienceAlansari et al1 recently have published in The Journal the results of a proof-of-concept, single-center, randomized trial evaluating the efficacy and safety of caffeine citrate in infants ≤4 months presenting to the emergency department with apnea-associated bronchiolitis during 3 bronchiolitis seasons..